直接作用抗病毒疗法治疗巴塞罗那临床肝癌分期 B/C 期丙型肝炎病毒感染患者。
Direct-Acting Antiviral Therapy for Hepatitis C Virus in Patients with BCLC Stage B/C Hepatocellular Carcinoma.
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
出版信息
Viruses. 2022 Oct 22;14(11):2316. doi: 10.3390/v14112316.
BACKGROUND
The benefits of hepatitis C virus (HCV)eradication for hepatocellular carcinoma (HCC) patients in Barcelona Clinic Liver Cancer (BCLC) stage B/C remain uncertain.
METHODS
In this hospital-based cohort study, all HCV-infected patients with BCLC stage B/C HCC during the period January 2017 to March 2021 were retrospectively screened, with 97 patients who had completed direct-acting antiviral (DAA) therapy being enrolled for final analysis.
RESULTS
In total, the sustained virological response (SVR) rate was 90.7%. In logistic regression analysis, progressive disease (PD) to prior tumor treatments was significantly associated with SVR failure (odds ratio 5.59, 95% CI 1.30-24.06, = 0.021). Furthermore, the overall survival (OS) rate was significantly higher in the SVR group than that in the non-SVR group (1-year OS: 87.5% vs. 57.1%, = 0.001). SVR was found to be an independent factor related to OS (hazard ratio 8.42, 95% CI 2.93-24.19, = 0.001). However, even upon achieving SVR, the OS rates in BCLC stage C or Child-Pugh stage B patients remained poor.
CONCLUSIONS
In BCLC stage B/C HCC, DAA could achieve a high SVR rate except in those patients with PD to prior HCC treatments. SVR was related to improvements in OS; therefore, DAA therapy should be encouraged for patients diagnosed without a short life expectancy.
背景
对于巴塞罗那临床肝癌（BCLC）分期 B/C 的肝细胞癌（HCC）患者，消除丙型肝炎病毒（HCV）的益处仍不确定。
方法
在这项基于医院的队列研究中，回顾性筛选了 2017 年 1 月至 2021 年 3 月期间所有患有 BCLC 分期 B/C HCC 的 HCV 感染患者，最终纳入了 97 例完成直接作用抗病毒（DAA）治疗的患者进行最终分析。
结果
总的来说，持续病毒学应答（SVR）率为 90.7%。在逻辑回归分析中，先前肿瘤治疗的进展性疾病（PD）与 SVR 失败显著相关（优势比 5.59，95%CI 1.30-24.06， = 0.021）。此外，SVR 组的总生存率（OS）明显高于非 SVR 组（1 年 OS：87.5% vs. 57.1%， = 0.001）。SVR 是与 OS 相关的独立因素（风险比 8.42，95%CI 2.93-24.19， = 0.001）。然而，即使实现了 SVR，BCLC 分期 C 或 Child-Pugh 分期 B 患者的 OS 率仍较差。
结论
在 BCLC 分期 B/C HCC 中，DAA 可实现高 SVR 率，但对于先前 HCC 治疗发生 PD 的患者除外。SVR 与 OS 改善相关；因此，应鼓励对预期寿命较短的患者进行 DAA 治疗。
Zotero 插件